Use of sedatives and neuromuscular blockers in a cohort of patients receiving mechanical ventilation

Alejandro Arroliga, Fernando Frutos-Vivar, Jesse Hall, Andres Esteban, Carlos Apezteguía, Luis Soto, Antonio Anzueto

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143 Scopus citations

Abstract

Objective: To describe the use of sedatives and neuromuscular blocking agents (NMBs) and their impact in outcome in an international cohort of patients receiving mechanical ventilation. Methods: We analyzed the database of a prospective, multicenter cohort of 5,183 adult patients who received mechanical ventilation for > 12 h. We considered that a patient received a given agent when it was administered for at least 3 h in a 24-h period. Results: A total of 3,540 patients (68%; 95% confidence interval [CI], 67 to 69%) received a sedative at any time while receiving mechanical ventilation. The median number of days of use was 3 (interquartile range [IQR], 2 to 6 days). The persistent use of sedative was associated with more days of mechanical ventilation (median, 4 days [IQR, 2 to 8 days], vs 3 days [IQR, 2 to 4 days] in patients who did not receive sedatives [p < 0.001]); more weaning days (median, 2 days [IQR, 1 to 3 days], vs 2 days [IQR, 1 to 5 days] in patients who did not receive sedatives [p < 0.001]); and longer length of stay in the ICU (median, 8 days [IQR, 5 to 15 days], vs 5 days [IQR, 3 to 9 days] in patients who did not receive sedatives [p < 0.001]). Six hundred eighty-six patients (13%; 95% CI, 12 to 14%) received an NMB for at least 1 day. The median number of days of use was 2 (IQR, 1 to 4 days). The administration of an NMB was independently related with age, a normal previous functional status, main reason of mechanical ventilation (patients with ARDS received more NMBs), and with patient management (patients requiring permissive hypercapnia, prone position, high level of positive end-expiratory pressure, and high airways pressure). Conclusions: The use of sedatives is very common, and their use is associated with a longer duration of mechanical ventilation, weaning time, and stay in the ICU. NMBs are used in 13% of the patients and are associated with longer duration of mechanical ventilation, weaning time, stay in the ICU, and higher mortality.

Original languageEnglish (US)
Pages (from-to)496-506
Number of pages11
JournalChest
Volume128
Issue number2
DOIs
StatePublished - Aug 2005

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Keywords

  • ICU
  • Mechanical ventilation
  • Neuromuscular blocking agents
  • Sedatives

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Arroliga, A., Frutos-Vivar, F., Hall, J., Esteban, A., Apezteguía, C., Soto, L., & Anzueto, A. (2005). Use of sedatives and neuromuscular blockers in a cohort of patients receiving mechanical ventilation. Chest, 128(2), 496-506. https://doi.org/10.1378/chest.128.2.496